PCOS Affects 1 In 10 Women: Here's Everything You Need To Know

One of the most common endocrine disorders affecting women of reproductive age today is PCOS, or polycystic ovarian syndrome. This condition has a negative impact on a woman's hormones and can lead to a variety of frustrating and serious health conditions. "Specifically, people with PCOS have abnormally high levels of androgen hormones [like testosterone], which can disrupt the balance of hormones that regulate the menstrual cycle and [can] prevent ovulation," senior scientist Krystal Thomas-White told HuffPost.

Despite how common it is, many women are unfamiliar with PCOS and how it can affect them. The disease is also unpredictable and difficult to understand and diagnose. According to a 2017 study published in the Journal of Clinical Endocrinology & Metabolism, women often experience a two-year delay between noticing symptoms, such as difficulty losing weight and experiencing irregular periods, and receiving an official diagnosis. They also end up seeing more than three healthcare professionals, a journey that causes sadness and frustration and one which can negatively impact an individual's mental health. Educating yourself on the signs of PCOS as well as tips for managing an official diagnosis may help circumvent more serious health conditions down the line.

Due to the wide variety of symptoms associated with PCOS, acquiring a diagnosis can be difficult. Each woman's symptoms can present differently. As a result, although millions of women are affected by PCOS and PCOS-related symptoms, roughly 50% go undiagnosed. "Your symptoms can be vague or mimic symptoms of other conditions, so PCOS can go undiagnosed for a while," Jessica Chan, a reproductive endocrinologist and PCOS specialist, shared with Cedars-Sinai. "There's no single test for it, but a physical exam, ultrasound, and blood tests can help diagnose PCOS." Because of this, it can take years and visits to multiple medical professionals before a clear diagnosis is obtained. This lengthy, frustrating process can cause feelings of confusion and powerlessness for women who simply want to figure out what is going on with their bodies.

The Rotterdam criteria is the most widely-used PCOS diagnosis tool. According to this criteria, irregular or non-existent menstrual periods, polycystic ovaries identified via an ultrasound, and hyperandrogenism identified via a blood test are the main symptoms of this disorder. Women must present two of the three to receive an official diagnosis. In addition, a handful of miscellaneous symptoms are generally associated with PCOS as well, including fertility problems, hormonal acne, dark skin patches, skin tags, pelvic pain, and chronic mood disorders.

Women with PCOS often experience a combination of psychological and physiological stress in their bodies. The internal stress caused by imbalanced hormones, severe dieting and exercise, unhealthy eating habits, poor sleep, and environmental toxins can cause the body's adrenal glands to release more of the stress hormone cortisol. Cortisol serves an important function by regulating blood sugar and blood pressure and managing your body's sleep schedule. It is also a major player in regulating your body's metabolism. However, when cortisol levels are too high, it can have a detrimental effect on just about every system and organ in the form of inflammation, weight gain, poor bone formation, and suppressed reproductive function.

With the increased production of cortisol comes an increase in DHEA-S levels, or androgens. Also known as the male sex hormones, androgens include testosterone. When the body has too much testosterone, it can lead to conditions such as hirsutism, or extra hair growth on the face and body, something many women with PCOS struggle with. Cortisol also signals a need for the release of glucose into the bloodstream for the muscles, a physiological response designed to help us react to stressful, fight-or-flight situations. But in the modern world, most women aren't constantly in life or death situations, so the excess glucose doesn't have anywhere to go. Instead, it forces the body to raise the amount of insulin it's producing. However, in women with PCOS, this increase in insulin may not work the way it should.

As a result of both insulin resistance and oxidative stress, women with PCOS are often prone to chronic, low-grade inflammation throughout their bodies. Normally, inflammation is the body's way of fighting off perceived threats like illness. But chronic inflammation in people with PCOS is triggered when it shouldn't, and it presents itself in a number of ways, including swelling or heat, headaches, and joint pain. "Research shows that people with PCOS show evidence of all-over inflammation, which is associated with heart disease and other illness," clinical dietitian Amanda Stathos told John Hopkins Medicine. "The Mediterranean diet eliminates saturated fats, processed meats, and refined sugar, which makes it a powerful tool to address inflammation ... Substituting whole, unprocessed options for inflammatory items can set the stage for better long-term health."

While no one food or diet is a cure for PCOS-related inflammation, incorporating anti-inflammatory foods such as healthy fats, leafy greens, berries, and omega-3 fatty acids found in fatty fish or supplements into your diet can help. Processed snacks, fried foods, sugary beverages including soda and fruit juice, and refined flour, pasta, white rice, and bread are good to limit or enjoy in moderation. This is because these types of foods have had all of their nutrients and fiber removed. They are digested more quickly than whole foods, leading to spikes in blood sugar that can increase the body's inflammatory response and hunger.

Gradual weight gain is a common side effect of PCOS, affecting roughly half of all women with the condition. Many women discover they have the condition after having a difficult time losing weight despite dieting or exercising regularly. This frustrating process is normally the result of their bodies' inability to process insulin correctly, causing a buildup of glucose in the body and weight gain primarily in the abdomen. If left unchecked, PCOS-related weight gain may lead to an increased struggle with menstrual irregularity and infertility.

However, the idea that all women with PCOS are overweight or that a thin person cannot be diagnosed with PCOS is a myth. "There's a misconception that you have to be the stereotypical overweight woman," certified health coach Amy Medling explained to Everyday Health. The truth is that PCOS does not discriminate based on size, shape, or ethnicity. Aiming for a healthy weight for your body is thought to help balance hormones and may also help regulate your periods, which can be achieved through regular activity and a balanced diet.

The imbalance of hormones that occur alongside PCOS often leads to frustrating physical symptoms including excessive hair growth and acne. Some women notice an increase in dark, coarse hairs on their upper-lip, jaw, back, or chest as the result of an excess in male sex hormones such as testosterone. Conversely, some women experience hair thinning and hair loss as the result of PCOS. This is largely due to the high levels of androgens their bodies are producing. These hormones interfere with the natural growth and shedding schedule by decreasing the amount of time each strand of hair is in the growth phase.

Severe acne is also a major indicator of hormonal imbalances caused by PCOS, especially in adult women. Thanks to the high levels of androgens, the body produces more oil and decreases cell turnover which can lead to clogged pores and pimples. "These two processes combine to aggravate both comedonal – blackhead type — and inflammatory — red pimple type — acne," professor of dermatology Rachel Reynolds told Insider. This type of acne may appear as large, painful pimples on the jaw, arms, upper back, or chest. Taking hormonal birth control pills, limiting simple carbohydrates and red meat, and applying topical creams including retinoids or salicylic acid may help manage PCOS-related acne flare ups.

A wealth of evidence suggests that diet and exercise are important for managing PCOS. "I recommend my patients exercise at least 30-40 minutes, 3-4 times a week and stay active on other days," reproductive endocrinologist, PCOS specialist, and assistant professor of obstetrics and gynecology Jessica Chan shared with Cedars-Sinai. "I also suggest a carbohydrate-restricted diet, since women with PCOS don't always process carbohydrates as easily as other women." There is conflicting advice amongst medical experts as to whether high-intensity exercise is helpful or harmful for women with PCOS, but most agree that, above all, it's important to find exercise you enjoy. Walking, practicing yoga, bike riding, dancing, or slow, sustained resistance training are all great ways to get in the necessary amount of activity.

When it comes to food, limiting refined carbohydrates and sugars is generally recommended due to their association with glucose storage and insulin resistance. Swap white rice and bread for whole grain, high-fiber options, and incorporate plenty of fresh fruits and vegetables and minimally-processed foods into your daily diet. It's also important to keep hydrated by drinking water and tea over sugary drinks.